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HomeMy WebLinkAbout41013-Z F84t ��G Town of Southold 12/28/2016 0 o P.O.Box 1179 ¢i 53095 Main Rd 14r Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 38729 Date: 12/28/2016 THIS CERTIFIES that the building DECK Location of Property: 60125 North Rd Unit 4D, Greenport SCTM#: 473889 Sec/Block/Lot: 44.1-1-16 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 9/16/2016 pursuant to which Building Permit No. 41013 dated 9/26/2016 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is: DECK ADDITION TO AN EXISTING CONDO (UNIT 4D)AS APPLIED FOR The certificate is issued to RafIloer,William of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED Aarizo Signature o�SU 4�o TOWN OF SOUTHOLD �y BUILDING DEPARTMENT z ' TOWN CLERIC'S OFFICE SOUTHOLD, NY dol � dao BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permit#: 41013 Date: 9/26/2016 Permission is hereby granted to: Raffloer, William PO BOX 708 Greenport, NY 11944 To: replace existing deck addition as applied for with flood permit per Trustees. At premises located at: 60125 North Rd Unit 4D, Greenport SCTM # 473889 Sec/Block/Lot# 44.1-1-16 Pursuant to application dated 9/16/2016 and approved by the Building Inspector. To expire on 3/28/2018. Fees: Flood Permit $100.00 CO -ADDITION TO DWELLING $50.00 SINGLE FAMILY DWELLING-ADDITION OR ALTERATION $288.00 Total: $438.00 1 & Vli ing Inspector Foi rrr No 6 TOWN of soUT14of-D BU(LDING DEPARTMENT TOWN BALL 768-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter or ink and submitted to the Building Department with the following.- A- ollowing:A. For new building or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. Fina( Approval from Health Dept- of water supply and sewerage-disposal(S-9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1% lead. 5. Commercial building, industrial building, multiple residences and similar buildings and installations,a certificate of Code Compliance from architect or engineer responsible for the building. b. Submit Planning Board Approval of completed site plan requirements. 4 B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and"pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets,building and unusual natural or topographic features. 2. A properly completed application and consent to inspect signed by the applicant. If a Certificate of Occupancy is denied,the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees 1. Certificate of Occupancy-New dwelling$50.00,Additions to dwelling$50.00,Alterations to dwelling$50.00, Swimming pool$50.00,Accessory building$50.00,Additions to accessory building$50.00,Businesses$50.00. 2. Certificate of Occupancy on Pre-existing Building- $100.00 3. Copy ol`Certi_Tcafg-if accupancy-T-2 -- - 4. Updated Certificate of Occupancy- $50.00 5. Temporary Certificate of Occupancy-Residential$15.00, Commercial$15.00 Date. her ID-ti 9 9 1C New Construction:` Old or Pre-existing Building: l/ (check one) Location of Property: G005, q C&L K-g Gr�enpo rf House No. ( Street Hamlet Owner or Owners of Property: Suffolk County Tax Map No 1000, Section Ik4 1 Block. Lot Subdivision Filed Map. Lot: Permit No. H I N3 Date of Permit. Applicant: Health Dept. Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: t/ (check one) - ---------------- - ------------- ------------ ------- -------- -- - --- ----- --- --------- - ---- ---- - - -- ---- - - -- Fee Submitted: $ A6cant cant Signature 1 O��Of SOUjhol � o ol'��OUNi`10� TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLEIG. [ ] FOUNDATION 2ND [ ] SULATION [ ] FRAMING / STRAPPING [ FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) REMARKS: ryNh Ilk Cl D DATE Al k l INSPECTOR FIELD lNSPEC.tWN nVOR'r AAT COQ, 5 FOUhDAMON (1ST) FOUND,4,nO* '(Mb) ROUGES FR��Q & CP PLU151RG TNSUT:,ATXON PES,N. � STATE ENERCrY CODB rte, S t Anra, S rn Pj °o TOWNbF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST BUILDING DEPARTMENT Do you have or need the following,before applying? TOWN HALL Board of Health SOUTHOLD, NY 11971 4 sets of Building Plans TEL: (631) 765-1802 Planning Board approval FAX: (631) 765-9502 Survey SouthoIdTown.NorthFork.net PERMIT NO. 41 f Check Septic Form N.Y.S.D.E.C. Trustees C.O.Application 1 Flood Permit Examined 120 Single&Separate Storm-Water Assessment Form Contact: _ Approved ,20 Mail to: Disapproved a/c Cy Phone: (Q,3( .2-Al�¢ � Expiration �kb ,20 15t[EUV[E n Building Inspector V SEP 1 6 2016 PPLICATION FOR BUILDING PERMIT BUILDING DEPT. Date Sne7 rt be, '� , 20_%_ TOWN OF SOUTHOLINSTRUCTIONS ID a. This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises,relationship to adjoining premises or public streets or areas, and waterways. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application,the Building Inspector will issue a Building Permit to the applicant. Such a permit shall be kept on the premises available for inspection throughout the work. e.No building shall be occupied or used in whole or in part for any purpose what so ever until the Building Inspector issues a Certificate of Occupancy. f. Every building permit shall expire if the work authorized has not commenced within 12 months after the date of issuance or has not been completed within 18 months from such date. If no zoning amendments or other regulations affecting the property have been enacted in the interim,the Building Inspector may authorize,in writing,the extension of the permit for an addition six months.'Thereafter,a new permit shall be required. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold,Suffolk County,New York, and other applicable Laws,Ordinances or Regulations,for the construction of buildings,additions, or alterations or for removal or demolition as herein described. The applicant agrees to comply with all applicable laws,ordinances,building code,housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. (Sig&e of applicant or name,if a corporation) P. C).&Y 'a Sgu-t6®Id NY IN71 (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineers general contractor, electrician,plumber or builder Amr^T Name of owner of premises Winn , Rte,Orf td Qr and Sy4.*4pul a n� (,',rv;0 e (As on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer (Name and title of corporate officer) Builders License No. Plumbers License No. If License No. Other Trade's License No. 1. Location of land on which proposed work will be done: GOIJ! CP 11 GternOarfi House Number Street Hamlet County Tax Map No. 1000 Section 44.1. Block Lot Subdivision SCr braa2:yi1laGt C0ndom'4%!y ,% Filed Map No. Lot EtD 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy Condo 1N;t1n Decr, b. Intended use and occupancy C OnJd \Al;It, RgplaCeJ Dr-ch 3. Nature of work(check which applicable):New Building Addition Alteration Repair Removal Demolition e/ Other Work Replace DOCK .A KI-%j -� (Description) 4. Estimated Cost Fee (To be paid on filing this application) 5. If dwelling,number of dwelling units 4- Number of dwelling units on each floor IV B If garage, number of cars A//A- 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. 7. Dimensions of existing structures, if any: Front t— 0 1 1) Rear -JY -I '/117 Depth I Q' Height f -gtv/Zv' Number of Stories AUA Dimensions of same structure with alterations or additions: Front ��I-ld" Rear i77 io" Depth q"-11 '14"' Height V-9 `fa' Number of Stories 8. Dimensions of entire new construction: Front ear 33'-ld" Depth '7 Height 71-03"' Number of Stories NIA, 9. Size oflot: Front 366 , GcK' Rear 3q2. g9 Depth 10. Date of Purchase Name of Former Owner 11. Zone or use district in which premises are situated R R R i G k n ca s ity Rer5 i den t ra l 12. Does proposed construction violate any zoning law, ordinance or regulation?YES NO 13. Will lot be re-graded? YES NO Will excess fill be removed from premises? YES NO yy�,,. ROffI09' owl 14. Names of Owner of premises su'ZawRe Ni.,itlie Address LOW CR 4% GrffqM(r Phone No. (SIQ10-9013 Name of Architect Address Phone No Name of Contractor Address Phone No. 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO ✓ * IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY BE REQUIRED. b. Is this property'within 300 feet of a tidal wetland? * YES NO_V * IF YES,D.E.C. PERMITS MAY BE REQUIRED. 16. Provide survey,to scale, with accurate foundation plan and distances to property lines. 17. If elevation at any point on property is at 10 feet or below,must provide topographical data on survey. 18. Are there any covenants and restrictions with respect to this property? * YES V NO * IF YES, PROVIDE A COPY. STATE OF NEW YORK) Notary P bl c1,,State of New York SS: No.01 BU6185050 COUNTY OF SOC1' LA-- Qualified in Suffolk County ��.� -- CC Commission Expires April 1s4,�c) %7_0 A13 Cti7tM50tS being duly sworn,deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)He is the (Contractor,Agent,Corporate Officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this �p day of L" 20) Notary Public Signature of Applicant Town Hall Annex John M.Bredemeyer III,President `' s<c Michael J.Domino,Vice-President 54375 Route 25 `'� ��'" � P.O.Box 1179, ", y" x Glenn Goldsmith " CA, Southold New York 11971 A.Nicholas Krupski Telephone(631) 765-1892 Charles J.Sanders Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF,SOUTHOLD Permit No.: 8846A Date of'Receipt of Application: June 17, 20'16 Applicant: Sea Breeze Village Condominiums c/o Edmund John Tiedemann SCTM#: 1000-44.1-1' (Lots 1 — 16) Project,Location: 60125 Route 48, Greenport Date of Resolution/Issuance: July 20, 2016 Date of Expiration: July 20, 2018 Reviewed by: Board of Trustees Project;Description: Replace the existing seaside decks on,all 16 condominium units; for Units 1 A, 1 B, 1 C, 2A, 213; 2C, 3A, 313, 3C, 4A, 413, and 4C construct a proposed 139sq.ft. upper deck with a 13.7sq.ft. stair landing, and 41.69sq.ft. staircase to ground; Unit 1 D construct a proposed 240sq.ft. upper deck, a 13.7sq.ft. stair landing and a 41.69sq.ft. staircase to ground; Units 213, 3D and 4D construct a proposed 205.8sq.ft. upper deck, a 13.7sq.ft. stair landing, and a 41.69sq.ft. staircase to ground. Findings: The project meets all the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code. The issuance of an Administrative Permit allows for the operations as indicated on the project plan submitted by Joan Chambers, received June 17, 2016, and stamped approved on July 20, 2016. Special Conditions: None. Inspections: Final Inspection. If the proposed activities do not meet the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code, a Wetland Permit will be required. : This is not a determination from any other agency. John M. Bredemeyer, III President Board of Trustees John M.Bredemeyer III,President ar.�QUTown Hall Annex �_ Michael J.Dono,Vice-President !.®•' � ' 54375 Route 25 mi P.O.Box 1179 Glenn Goldsmith Southold,New York 11971 A.Nicholas Krupski .G Telephone(631) 765-1892 Charles J.Sanders O� Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD = CERTIFICATE OF COMPLIANCE # 1297C Date: Decemberl4,1016 THIS CERTIFIES that_Leplzcciiieht of the eiistio g-�seasidc,deeks ---;all 15 condominium units; _ for Units IA. 1B 1C 2A,2B 2C 3A 3B, 3C 4A,4B, and 4C-'coiTStriict a proposed 139sa.ft. 3 ;upper deck wkh a-17sc stair landi i ,iind 4L6% ft! staircas&to acatin&Uaits 2I] -3D-arid 4D construct'A'pr6L6cd`205"8$q ff iiper deck a 13 7sq ft stair,landina 6d a 41.69sg.ft,, staircase fo roundLUnit 1D,:S&M-#44 I-1-'1 (no c©itstrtiction perform'edihat was-'awlied fort; At 60125 Route,48,_Greenport '- Suffolk County Tax Map#1000-44.1-1-246° Conforms to the application for a Trustees Permit heretofore filed in this office Dated June,17,2016 pursuant to which Trustees Administrative Permit#8846A, Dated lulu 20,.201,6,was issued and conforms to all of the requirements.and conditions of the applicable provisions of law. The project for which this certificate is being issued is for the reiitacement ofthe- existing'seaside decks'iin-all-l5-condominium-units-forthiit's, MAB, 1C,2A,2B;2C 3A 313, 3C 4A,•4B -and 4G,construct-a.pr6pa6ed-139§g(ALupperdeck with a 13 7sq ffi -sfair landing, and 41 69sn it staff 6iLae to around-,-Llnits'2D~ 3D and 4D constntcL, au6pased 205i8sq-A t er'declt, a 13Jsq.f,;:stair landing,and a 41.69sc A.staiic€is tot roiiiidsi;; ' ` 1%ed Unit lD SCTM•#4414.4 (no,co_nstrttction.Rerfoi7ned it at'was appfar i ) ; The certificate is issued to',SIJA BItE11Z11 Vz 1AGE'' oNDOMINItJ1VI"owners®f tine aforesaid property. Yv_ ' LY.t Lud"i JiYa''i f fp�t,� v71 i { Authorized Signature Scott A. Russell SUPERVISOR , �, �, - I��1CA\1�A\_ �G�lE��1C)EN�C' SOUTHOLD TOWN HALL-P.O.Box 1179 53095 Main Road-SOUTHOLD,NEW YORK 11971 Town of Southold a_ CHAPTER 236 - STORMWATER MANAGEMENT WORK SHEET ( TO BE COMPLETED BY THE APPLICANT ) DOES THIS PROJECT INVOLVE ANY OF THE F®F,I,OWING: (CHECK ALL THAT APPLY) Yes No ❑(f A. Clearing, grubbing, grading or stripping of land which affects more than 5,000 square feet of ground surface. ❑dB. Excavation or filling involving more than 200 cubic yards of material within any parcel or any contiguous area. ❑ vLI C. Site preparation on slopes which exceed 10 feet vertical rise to 100 feet of horizontal distance. ❑dD. Site preparation within 100 feet of wetlands, beach, bluff or coastal erosion hazard area. E][2/E. Site preparation within the one-hundred-year floodplain as depicted - ._... - -en--FIRM-Map-of-any water-enur sem------------- El�ilF. Installation of new or resurfaced impervious surfaces of 1,000 square feet or more, unless prior approval of a Stormwater Management Control Plan was received by the Town and the proposal includes in-kind replacement of impervious surfaces. If you answered NO to all of the questions above, STOP! Complete the Applicant section below with your Name, Signature, Contact Information, Date & County Tax Map Number! Chapter 236 does not apply to your project. If you answered YES to one or more of the above, please submit Two copies of a Stormwater Management Control Plan and a completed Check List Form to the Building Department with your Building Permit Application. APPLICANT: (Property Owner,Design Professional,Agent,Contractor,Other) S•C•T.M. = D000 Date istrict NAME: Lb 10% C6r%berS =moi_ —`-- _[�'_ fro Section Block Lot rOR BUILDI ' EPA TNIENT USE ONLY Contact Informat idn TdryrM1aie�umntt5 Reviewed By: Date: Ibl—A Property Address/ Location of Construction Work: — — — — — — — — — — --- - — — — A Approved for processing Building Permit. (a� C R 4'Q Stormwater Management Control Plan Not Required. — — — — — — — — — — — — — — — — — _ 6r"- ApOrT a1/Y Stormwater Management Control Plan is Required. (Forward to Engineering Department for Review:) FORM " SMCP-TOS MAY 2014 Town Hall AnnexGym Telephone(631-1802 54375 Main Road �c Fax(631) 734-9502 P.O. Box 1179 Southold, NY 11971-0959,. r BUILDING DEPARTMENT NOTICE OF UTILIZATION OF TRUSS TYPE CONSTRUCTION, PRE-ENGINEERED WOOD CONSTRUCTION AND/OR TIMBER CONSTRUCTION Date: 50,010 h bCr l S�" 2016 Owner. -\Arv,. R(Xff lorr arkd S"41%AT Pe,C6, V-dIg Location of Property: GG las C L2 49 �,71 KzU adrT j Please take notice that the (check applicable line): New residential structure Addition to existing residential strucfiure l: Rehabilitation to an existing residential structure to be constructed or performed at the,subject property reference above will atilize° (check applicable line): Truss type construction (TT) Pre-engineered wood construction (PW) Timber construction (TC) in the following locations) (check applicable line): Qerh Floor framing, including girders and beams(F) Roof framing (R) Floor and roof framing (FR) Signature: Name (person submitting this form): rlhe,7IA4-Lyp4 Capacity(check applicable line): Owner t/ Owner representative TrussResRegl5.docx Effective 1/1/2015 APPLICATION y ' PAGE I of a -- TOWN OF SOUTHOLD FLOODPLAIN DEVELOPMENT PERMIT APPLICATION This form is to be filled out in duplicate. SECTIO N 1: GFNERAL PROVISIONS APPLICANT to read and i I. No work may start until a permit is issued. 2- The permit may be revoked if any false statements are made herein_ 3. If revoked, all work must cease until permit is re-issued. 4. Development shall not be used or occupied until a Certificate of Compliance is issued. 5. The permit will expire if no work is commenced within six months of issuance. 6. Applicant is hereby informed that other permits may be required to fulfill local, state and federal regulatory requirements. 7. Applicant hereby gives consent to the Local Administrator or his/her representative to make reasonable inspections required to verify compliance. S. 1,THE APPLICANT,CERTIFY THAT ALL STATEMENTS HEREIN AND IN ATTACHMENTS TO THIS APPLICATION ARE,TO THE BEST OF MY KNOXVLEDGE,TRUE AND ACCURATE. (APPLICANT"S SFONATURE)L—yhfi� DATE SECITON 2: PR P SED D&LOPMENT M be con 1 ted by APPLICA1v _ NAME DRES TEL PH NE APPLICANT � U62C ' (per( BUILDERJor�c�c� csun�que . conte ENGINEER J Flo v D E _ m AC-�uct�- IQ -PR QJECT_LOCA-130 : • To avoid delay in processing the application. please provide enough information to easily identify the project location. Provide the street address, tot number or legal description (attach) and, outside urban areas, the distance to the nearest intersecting road or well-known landmark. A sketch attached to this application showing the project location would be helpful. FDP(93) APPLICATION _ PAGE 2 0174 ~ DESCRIPTION OF WORK (Check all applicable boxes)_ A. STRUCTURAL DEVELOPMENT ACTIVITY STRUCTURE TYPE ❑ New Structure ❑ Residential (1-4 Family) ---------- ❑ Addition ❑ I�esidcnital (Morethan-�—Familyj- ---- -- ❑ Alteration ❑ Non-residential (Floodprooffiing? ❑ Yes) ❑ Relocation D Combined Use (Residential & Commercial) ❑ Demo5don ❑ Manufactured (Mobile) biome (10 Manu- . Replacemeat factured Home Park? ❑ Yes) ESTIMATED COST OF PROJECT 5 S. OTHER DEVELOPMENT ACTIVITIES: p Fill ❑ Mining ❑ Drilling O Grading ❑ Excavation (Except for Structural Development Checked Above) ❑ Watercourse Alteration (Including Dredging and Channel Modifications) ❑ Drainage Improvements.(Including Culvert Work) ❑ Road, Street or"Br. Construction ❑ Subdivision (New or Expansion) ❑ Individual Water or Ser System , ❑ Other (Please SpectTy)` After completing SECTION 2, APPLICANT should submit form to Local Administrator for review. SE ION 3. FLOODPLAIN DETERMINATION o be completed by LOCAI. ADMINISTRATOR) The proposed development is located on FIRM Panel No.��� Dated The Proposed Development: ❑Is ►LIQ' located in a Special Flood Hazard Area (Notify the applicant that the application review is complete and NO FLOODPLL.AIN DEVELOPMENT PERMIT IS REQUIRED). ❑ Is located is a Special Flood Hazard Area. FIRM zone designation is Ft. NGVD (MSL) 1W-Year flood elevation at the site is: ❑ Unavailable ❑The proposed development is located in a floodway. FBFM Panel No. Dated ❑ See Section 4 for additional instructions. SIGNED DATE APPLICATION a PAGE 3 OF 4 SECTION 4- ADDITI NAL INFORMATION RE UTRED f To he completed by LOCAL ADMTNISTRATOR The applicant must submit the documents checked below before the application can be processed: ❑ A site plan showing the location of all existing structures, water bodies, adjacent roads, lot d'unensioas and proposed development. ----- —-- --- - --= ----EyDevclopm-ent-plans:dr-awn-tosealci-and-spccilisat-iotu-including-whcrc-applicable:-dr-tailsfor--.- anchoring structures, proposed elevation of lowest floor(including basement), types of water resistant materials used below the first floor, details of floodproofing of utilities located below the first floor and details of enclosures below the first floor. Also ❑Subdivision or ocher development plans(If the subdivision or other development exceeds 50 lots or S acres,whichever is the lesser, the applicant must provide 100-year flood elevations if they are not otherwise available). ❑ Plans showing the extent of watercourse relocation and/or landform alterations. ❑Top of new fill elevation Ft. NGVD (MSL). 0 Floodproofing protection level (non-residential only) Ft:NGVD (MSL). For floM� oofed structures, applicant must attach certification from registered engineer or architect ❑ Certification from a registered engineer that the proposed activity in a regulatory floodway will not result in Any increase in the, height of the 100-year flood. A copy of all data and calculations supporting, his finding must also be submitted. ❑ Other: E : PE IT RMINATI N completed by jDQ6L ADJM]NiD I have determined that the proposed activity: A.13 Is B.0 Is not in conformance with provisions of Local Law # . 19 The permit is issued subject to the conditions attached to and made part of this permit. SIGNED , DATE If BOX A h the k d, the Local Administrator may issue a Development Permit upon payment of designated fee. lf�OX TjH is chrt ked, the Local Administrator will provide a written summary of deficiencies. Applicant may revise and resubmit an application to the Local Administrator or may request a bearing from the Board of Appeals. APPLICATION a PAGE 4 OF 4 APPEALS Appealed to Board of Appeals? ❑ Yes ❑ No Hearing date: Appeals Boai d Decision --- Approved? ❑ Yes ❑ No Conditions - SECTION G AS-BUILT ELEVATIONS (To be subore Certificate of Compliance is issued The following information must be provided for project structures. This section must be completed by a registered professional engineer or a Gceased land surveyor (or attach a certification to this application). Complete I or 2 below. 1- Actual (As-Built) Elevation of the top of the lowest floor, including basement(in Coastal High Hazard eas, bottom of lowest structural member of the lowest floor, excluding piling and columns) u: FT. NGVD (MSL). ? Actual (As-Built) Elevation of Iloodproofmg protection is FT. NGVD (MSL). NOTE: Any work performed prior to submittal of the above information is at the risk of the Applicant. ECT7 N 7: COMPLIANCE AMON o be completed by LOCAL ADMINI TRAT R The LOCAL ADMINISTRATOR will completc "_this section as applicable based on inspection of the project to ensure compliance with the community's local law for flood damage prevention. INSPTECTIONS: DATE BY DEFICIENCIES? ❑ YES ONO DATE BY DEFICIENCIES? ❑ YES ❑ NO DATE BY DEFICIENCIES? DYES ONO SECTION 8. CERTIFICATE OF QOMPLIANCE(jo be completed bV LOCAL ADMINISTRAMR-1 Certificate of Compliance issued: DATE: BY: Attachment B SAMPLE CERTIFICATE OF COMPLIANCE for Development in a Special Flood Hazard Area • TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE FOR DEVELOPMENT IN A SPECIAL FLOOD HAZARD AREA (OWNER MUST RE'T'AIN THIS CERTIFICATE) PREMISES LOCATED AT: PERMIT NO. PERMIT DATE OWNERS NAME AND ADDRESS: CHECK ONE: 17 NEW BUILDING O EXISTING BUILDING O VACANT LAND THE LOCAL ADMINISTRATOR IS TO COMPLETE A. OR B. BELOW: A. COMPLIANCE IS HE, CERTIFIED WITH THE REQUIREMENTS OF LOCAL LAW # , 19_ SIGNED-. DATED: B. 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